冠脉旁路移植术后患者围手术危重期的ICU管理

Management of ICU in para-operation period after coronary artery bypass grafting

目的 探讨如何加强冠脉旁路移植术后围手术期危重病人的ICU管理与辅助治疗、提高术后成功率的方法。方法 采用ICU病房常规及有创监测、出凝血实验室监测、人工机械辅助通气及采用常规药物治疗。结果 术后所有病人均发生窦性心动过速 ,5 8 6 2 %发生心律失常 ,以室性期前收缩、房颤最为常见 ;全部病例中有 6 8 97%术后血压不稳定 ,其中低血压、休克 16例 ,高血压 4例 ;5例发生急性左心功能不全 ,由于发现及时经积极药物治疗全部恢复正常。对术后病人给予肝素拮抗剂—鱼精蛋白的比例为 1∶1～ 1 2 ,治疗效果理想 ;所有病人术后均在全麻未醒、气管插管下进入ICU病房。人工机械通气平均上机时间为 (12 35± 6 73)h ,血氧饱和度保持在 95 %以上。全部病人于 72h内安全渡过危重期转出ICU病房。结论 加强冠脉旁路移植术后围手术危重期的ICU管理是提高手术成功率的必要保证。

Objective To investigate how to increase the success rate after coronary artery bypass grafting(CABG)by improving the management in para-operation period in ICU.Methods Monitoring routine vital signals and coagulation,mechanical ventilation and regular drugs were used in this study.Results ① Sinus tachycardia happened to all the patients,58.62% patients got arrhythmia,arterial premature,ventricular premature and arterial fibrillation were common;68.97% patients'blood pressure were unstable,16 patients had low pressure even shock, 4 patients had hypertension,5 patients had acute heart failure.② The appropriate ratio of heparin and protamine sulfate was 1:1～ 1.2. ③ The average time of artificial mechanical ventilation were (12.35±6.73)hours,all the patients'SO 2 were higher than 95% and left ICU within 72 hours.Conclusion Improving the management in para-operation period after CABG in ICU is the assurance of increasing success rate of the operations.